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General NPI Number Information
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NPI Number | 1265315592
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Entity Type | Organization
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Legal Business Name | SPOCS ORTHODONTICS, LLC
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 3200 4TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33704-2127
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Country | US
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Telephone | 727-242-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 330 43RD AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33703-4834
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Country | US
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Telephone | 727-242-8000
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | AHMED MANSOUR
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Credential |
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Telephone | 917-209-6466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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